Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213746 DEA: 080Q75U4 EFIS: 0817000114
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD,RIV-60-R4.6/R9.9, R0.0/12.2
Work Description: REPLACEMENT OF TWO OUTSIDE LANES AND CONCRETE SLABS
Location Description:
Contractor Name: J McLoughlin Engineering
Contractor Address: 10641 Fulton Court, Rancho Cucamonga, CA 91730
Resident Engineer: Mujahid Qureshi Structure Rep.: Ching Chuang
DIME Sample ID: 2020-03-07-3
TL Number from the TL Form: 999-307C
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 03/07/2020
Date that the sample was received by the laboratory/organization performing the testing: 03/09/2020
The quantity of what the sample constitutes: 6
A brief description of the sample: 6x12 RSLCB cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 999-307C
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NA
The concrete mix design number: NA
The truck number from where the sample was collected: NA
The batch plant ticket number from where the sample was collected: NA
Concrete batch plant: NA
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Job Site
Where the material sample would have been placed if not sampled: EB RTE 60 LANE 3 AND 4 37492 TO 38683
From Lot No.: Unknown
Bag Lot No.: Unknown
DIME Test ID: 2020-03-07-3-1
Test Method: ASTM C39-17a: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: 9098293029
Data has not been verified.
